Renal Function in Patients with High Serum Fluoride Concentrations after Prolonged Sevoflurane Anesthesia

Higuchi, Hideyuki; Sumikura, Hiroyuki; Sumita, Shinji; Arimura, Shinya; Takamatsu, Futoshi; Kanno, Masuyuki; Satoh, Tetsuo

doi:10.1097/00000542-199509000-00003

Cited by 96 publications

(27 citation statements)

References 26 publications

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“…Some studies have suggested that an agent that impairs renal tubules causes elevated NAG excretion in a delayed fashion. Higuchi et al [29] observed a peak on day 2 after exposure to inorganic fluoride. Shimada et al [30 ]measured elevated levels after 12 h and a peak level after 48 h following exposure to mercury in rats.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane Protects against Acute Kidney Injury in a Small-Size Liver Transplantation Model

et al. 2010

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Background: Living donor liver transplantation (LDLT) patients run the risk of developing acute kidney injury (AKI) and subsequent chronic kidney disease, affecting morbidity and mortality. Sevoflurane has anti-inflammation properties, and renal ischemia/reperfusion under sevoflurane anesthesia resulted in drastic improvements in renal function. Extrahepatic metabolism of sevoflurane has been reported in patients undergoing liver transplantation, and might lead to nephrotoxicity. However, whether sevoflurane anesthesia is safe with regard to renal function in small-size liver transplantation needs further investigation. As neutrophil gelatinase-associated lipocalin (NGAL) is an early predictive biomarker of AKI, we looked at the renal effects of sevoflurane in a rat liver transplantation model using small-for-size grafts to investigate the changes of NGAL level and kidney histology. Methods: Sixty male Sprague-Dawley rats were randomly divided into 2 groups after 50% size liver transplantation. Rats were anesthetized with chloral hydrate or with sevoflurane and subjected to liver transplantation. Twelve rats in each group were used for the survival study and 6 rats were used for the hemodynamic study. Six rats in each group were sacrificed 2 or 24 h after reperfusion. We harvested kidneys and serum for further analysis, including histological and functional parameters; TNF-α, IL-6 and NGAL immunoassay; expressions of myeloperoxidase (MPO) activity; and NF-ĸB in renal tissues. Results: Rats in the sevoflurane group had significantly lower Scr 24 h after reperfusion compared with those in the chloral hydrate group. Rats in the sevoflurane group demonstrated significantly reduced NGAL concentrations compared with rats in the chloral hydrate group 2 h after reperfusion. Epithelial necrosis in the chloral hydrate group (3.2 ± 0.8) was greater than that in the sevoflurane group (1.5 ± 1.1; p < 0.05). Sevoflurane anesthesia resulted in significantly lower plasma TNF-α and IL-6 concentrations and reduced MPO concentrations 2 h after reperfusion (p < 0.05). NF-ĸB protein levels 2 h after reperfusion increased by at least 110% in the chloral hydrate group relative to the sevoflurane group 2 h after reperfusion (p < 0.05). However, the urine inorganic fluoride concentrations increased significantly (p < 0.001) 2 h after reperfusion in the sevoflurane group (6.1 ± 1.5 µmol·l^–1) compared with the chloral hydrate group. Conclusions: Sevoflurane anesthesia can attenuate renal injury and modulate inflammatory cascades in small-size liver transplantation using rat models.

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Section: Discussionmentioning

confidence: 99%

Sevoflurane Protects against Acute Kidney Injury in a Small-Size Liver Transplantation Model

et al. 2010

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“…Plasma ROS products are more decreased after the administration of sevoflurane than after desflurane, providing beneficial effects on the cellular metabolism now that biochemical oxidative products are decreased (2,21). In our studies, we aimed to show the advantages of lowflow anesthesia with both sevoflurane and desflurane in laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Effects of Low-Flow Anesthesia with Inhalation agents in Patients undergoing Laparoscopic Surgery

Sivaci¹,

Demir²,

Köken³

et al. 2012

Journal of Medical Biochemistry

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Summary: This study was designed to investigate the effects of low-flow anesthesia with sevoflurane and desflurane on renal and hepatic functions in patients undergoing laparoscopic abdominal surgery. Twenty patients with ASA I or II (American Society of Anesthesiologists classification) physi cal scores were included in the study. There were no signifi cant differences between sevoflurane and desflurane groups with respect to age, weight, body mass index, duration of the operation and the anesthesia. In both groups, renal function parameters such as urea, BUN, creatinine and calculated creatinine clearance did not show significant differences at 24 and 48 hours. Homocysteine levels, which showed renal metabolic function, did not change significantly at 24 and 48 hours when compared to baseline le vels in both groups. Transaminases were not significantly different between the two groups from baseline to 24 and 48 hours. These differences between the preoperative and post operative values of biochemical parameters were similar for both anes thetic groups (p>0.05). Low-flow anesthesia did not cause impairment in terms of renal and hepatic functions.

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“…No evidence of impaired renal concentrating ability has been demonstrated with sevoflurane [7], although an increase in urinary N-acetyl-bglucosaminidase (NAG) has been noted in patients undergoing prolonged anaesthesia in conjunction with antibiotic therapy [8]. Other work using NAG has shown a similar effect on renal tubules to that of isoflurane [9].…”

Section: Discussionmentioning

confidence: 99%

Serum glutathione S‐transferase concentrations and creatinine clearance after sevoflurane anaesthesia

et al. 1997

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SummaryThe effects of sevoflurane and isoflurane on serum glutathione S-transferase concentrations and creatinine clearance were compared in 50 ASA I-III patients aged over 18 years undergoing body surface surgery of 1-3 h predicted duration. Patients randomly received sevoflurane (n ¼ 24) or isoflurane (n ¼ 26) in nitrous oxide and oxygen (FIO 2 ¼ 0.4) via a nonrebreathing system. Fluids were standardised and patient's lungs ventilated to normocapnia. Expired concentration of anaesthetic agent was adjusted to maintain systolic arterial pressure between 70 and 100% of baseline. Patients received significantly less (p < 0.05) sevoflurane (1.0 MAC-h) than isoflurane (1.5 MAC-h). Using serum glutathione S-transferase concentrations and creatinine clearance as markers of hepatic and renal function respectively, no statistically significant differences were identified between the groups. Although sevoflurane has been administered to over one million patients in Japan and undergone extensive clinical trials in Europe and North America, concerns remain about its potential for organ toxicity [1,2]. A rate of metabolism which is greater than isoflurane or enflurane [3] may increase the risk of hepatotoxicity. Serum glutathione S-transferase (GST) concentration was used in this study as a specific marker of hepatocellular injury owing to its location in centrilobular hepatocytes and a short serum half-life [4,5].Sevoflurane is metabolised to inorganic fluoride which has been associated with nephrotoxicity in patients receiving methoxyflurane [6]. No evidence of impaired renal concentrating ability has been demonstrated with sevoflurane [7], although an increase in urinary N-acetyl-bglucosaminidase (NAG) has been noted in patients undergoing prolonged anaesthesia in conjunction with antibiotic therapy [8]. Other work using NAG has shown a similar effect on renal tubules to that of isoflurane [9]. In this study, serum fluoride concentrations were monitored and serum osmolality and creatinine clearance used as measures of renal function. MethodsWith University Ethics Committee approval and written informed consent, 50 ASA I-III patients were admitted to the study. All were in-patients over 18 years undergoing body surface surgery of 1-3 h predicted duration. Patients with evidence of hepatic or renal dysfunction or a history of heavy alcohol intake (>21 units.week ¹1 for men or >14 units.week ¹1 for women) were excluded. Patients receiving any drugs known to induce hepatic enzymes or who had received general anaesthesia within the previous week were also excluded and all women were tested to exclude pregnancy.Venous blood was drawn for baseline tests of hepatic function including aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) activities and serum GST concentration. Serum electrolytes, urea, fluoride, creatinine and osmolality were also measured. A urine sample was obtained for the measurement of urine osmolality and a timed urine collection was started on adm...

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Renal Function in Patients with High Serum Fluoride Concentrations after Prolonged Sevoflurane Anesthesia

Cited by 96 publications

References 26 publications

Sevoflurane Protects against Acute Kidney Injury in a Small-Size Liver Transplantation Model

Sevoflurane Protects against Acute Kidney Injury in a Small-Size Liver Transplantation Model

Biochemical Effects of Low-Flow Anesthesia with Inhalation agents in Patients undergoing Laparoscopic Surgery

Serum glutathione S‐transferase concentrations and creatinine clearance after sevoflurane anaesthesia

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